Provider Demographics
NPI:1679647424
Name:NORTHWEST ORTHOPAEDIC ASSOCIATES DBA NORTHWEST PHYSICAL THERAPY
Entity Type:Organization
Organization Name:NORTHWEST ORTHOPAEDIC ASSOCIATES DBA NORTHWEST PHYSICAL THERAPY
Other - Org Name:DBA NORTHWEST PHYSICAL THERAPY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-631-7898
Mailing Address - Street 1:7447 W TALCOTT
Mailing Address - Street 2:SUITE 501
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631
Mailing Address - Country:US
Mailing Address - Phone:773-631-4112
Mailing Address - Fax:773-594-2113
Practice Address - Street 1:7447 W TALCOTT
Practice Address - Street 2:SUITE 501
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631
Practice Address - Country:US
Practice Address - Phone:773-631-4112
Practice Address - Fax:773-594-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCN2029OtherMEDICARE RAILROAD
IL1618851OtherBCBS OF IL
IL205813Medicare ID - Type Unspecified
IL205832Medicare ID - Type Unspecified
ILDA9631Medicare ID - Type UnspecifiedMEDICARE RAILROAD CO